From the Guidelines
For chronic shoulder pain with limited range of motion, you typically don't need a CT scan as the first imaging test. Instead, your doctor will likely recommend starting with a plain X-ray, followed by an MRI if needed, as suggested by the American College of Radiology 1. X-rays can show bone-related issues like arthritis or calcifications, while MRI better visualizes soft tissues like rotator cuff tears, labral injuries, or inflammation without radiation exposure.
Key Points to Consider
- CT scans are generally reserved for specific situations where detailed bone imaging is needed, such as complex fractures or for surgical planning, as noted in the study by 1.
- If a CT is deemed necessary, contrast is typically only added when evaluating for certain conditions like infections or tumors.
- Before any advanced imaging, your doctor should perform a thorough physical examination and may try conservative treatments like physical therapy, anti-inflammatory medications, or possibly a corticosteroid injection.
- The imaging choice ultimately depends on your specific symptoms, physical exam findings, and suspected diagnosis, so follow your healthcare provider's recommendation based on your individual situation.
Imaging Options
- MRI of the shoulder without IV contrast is often the most appropriate study for nonlocalized shoulder pain and negative radiographs, as recommended by 1.
- MR arthrography, CT arthrography, or MRI shoulder without IV contrast are appropriate studies when physical examination is consistent with a labral tear and radiographs are normal, as suggested by 1.
- Ultrasound can be used to evaluate the acromioclavicular joint, the tendons of the rotator cuff, and the long head of biceps tendon, but it is operator dependent and limited in evaluation of other important deep shoulder structures and marrow, as noted in the study by 1.
From the Research
Chronic Shoulder Pain Diagnosis
For chronic shoulder pain with limited range of motion (ROM), the diagnosis and evaluation process is crucial. The following points highlight the key aspects to consider:
- Chronic shoulder pain can be caused by various conditions, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis 2.
- A clinical decision rule can help diagnose rotator cuff tears, and adhesive capsulitis can be associated with diabetes and thyroid disorders 2.
- Imaging studies, such as plain radiographs, magnetic resonance imaging (MRI), ultrasonography, and computed tomography (CT) scans, can be used to evaluate shoulder pathology 2, 3.
Imaging Modalities
The choice of imaging modality depends on the specific condition being evaluated:
- Plain radiographs can provide useful information, particularly with a history of trauma, but give limited information on soft tissue structures 3.
- Ultrasound is a useful and inexpensive means of assessing the biceps tendon and rotator cuff, but has limitations and varying reports on its accuracy 3.
- CT is most helpful in the evaluation of shoulder trauma, but gives limited information on soft tissues 3.
- MRI with or without intra-articular contrast is the most accurate imaging modality for evaluating shoulder pathology, allowing visualization of soft tissues that are often the source of pain 3.
CT Scan with or without Contrast
Specifically, for a CT scan:
- CT can be used to evaluate shoulder instability, particularly in cases where MRI is not available or contraindicated, when performed with intra-articular contrast 3.
- However, there is no clear indication that a CT scan with or without contrast is necessary for chronic shoulder pain with limited ROM, unless other imaging modalities are not available or contraindicated 3.